Abstract：
BACKGROUND: Acute stroke care demands fast procedures performed through the collaboration of multiple professionals across multiple organizations. Cloud computing and the wide adoption of electronic medical records (EMRs) enable health care systems to improve data availability and facilitate sharing among professionals. However, designing a secure and privacy-preserving EMR cloud-based application is challenging because it must dynamically control the access to the patient\'s EMR according to the needs for data during treatment.
OBJECTIVE: We developed a prototype of a secure EMR cloud-based application. The application explores the security features offered by the eHealth cloud-based framework created by the Advanced Secure Cloud Encrypted Platform for Internationally Orchestrated Solutions in Health Care Horizon 2020 project. This study aimed to collect impressions, challenges, and improvements for the prototype when applied to the use case of secure data sharing among acute care teams during emergency treatment in the Netherlands.
METHODS: We conducted 14 semistructured interviews with medical professionals with 4 prominent roles in acute care: emergency call centers, ambulance services, emergency hospitals, and general practitioner clinics. We used in-depth interviews to capture their perspectives about the application\'s design and functions and its use in a simulated acute care event. We used thematic analysis of interview transcripts. Participants were recruited until the collected data reached thematic saturation.
RESULTS: The participants\' perceptions and feedback are presented as 5 themes identified from the interviews: current challenges (theme 1), quality of the shared EMR data (theme 2), integrity and auditability of the EMR data (theme 3), usefulness and functionality of the application (theme 4), and trust and acceptance of the technology (theme 5). The results reinforced the current challenges in patient data sharing during acute stroke care. Moreover, from the user point of view, we expressed the challenges of adopting the Advanced Secure Cloud Encrypted Platform for Internationally Orchestrated Solutions in Health Care Acute Stroke Care application in a real scenario and provided suggestions for improving the proposed technology\'s acceptability.
CONCLUSIONS: This study has endorsed a system that supports data sharing among acute care professionals with efficiency, but without compromising the security and privacy of the patient. This explorative study identified several significant barriers to and improvement opportunities for the future acceptance and adoption of the proposed system. Moreover, the study results highlight that the desired digital transformation should consider integrating the already existing systems instead of requesting migration to a new centralized system.
OBJECTIVE: We developed a prototype of a secure EMR cloud-based application. The application explores the security features offered by the eHealth cloud-based framework created by the Advanced Secure Cloud Encrypted Platform for Internationally Orchestrated Solutions in Health Care Horizon 2020 project. This study aimed to collect impressions, challenges, and improvements for the prototype when applied to the use case of secure data sharing among acute care teams during emergency treatment in the Netherlands.
METHODS: We conducted 14 semistructured interviews with medical professionals with 4 prominent roles in acute care: emergency call centers, ambulance services, emergency hospitals, and general practitioner clinics. We used in-depth interviews to capture their perspectives about the application\'s design and functions and its use in a simulated acute care event. We used thematic analysis of interview transcripts. Participants were recruited until the collected data reached thematic saturation.
RESULTS: The participants\' perceptions and feedback are presented as 5 themes identified from the interviews: current challenges (theme 1), quality of the shared EMR data (theme 2), integrity and auditability of the EMR data (theme 3), usefulness and functionality of the application (theme 4), and trust and acceptance of the technology (theme 5). The results reinforced the current challenges in patient data sharing during acute stroke care. Moreover, from the user point of view, we expressed the challenges of adopting the Advanced Secure Cloud Encrypted Platform for Internationally Orchestrated Solutions in Health Care Acute Stroke Care application in a real scenario and provided suggestions for improving the proposed technology\'s acceptability.
CONCLUSIONS: This study has endorsed a system that supports data sharing among acute care professionals with efficiency, but without compromising the security and privacy of the patient. This explorative study identified several significant barriers to and improvement opportunities for the future acceptance and adoption of the proposed system. Moreover, the study results highlight that the desired digital transformation should consider integrating the already existing systems instead of requesting migration to a new centralized system.
摘要：
背景：急性中风护理需要通过跨多个组织的多个专业人员的协作来执行快速程序。云计算和电子病历（EMR）的广泛采用使医疗保健系统能够提高数据可用性并促进专业人员之间的共享。然而,设计一个安全和隐私保护的EMR基于云的应用程序是具有挑战性的，因为它必须根据治疗期间对数据的需求动态地控制对患者EMR的访问。
目的：我们开发了一个基于云的安全EMR应用程序原型。该应用程序探讨了基于eHealth云的框架提供的安全功能，该框架由高级安全云加密平台为医疗保健Horizon2020中的国际编排解决方案创建。这项研究旨在收集印象，挑战,以及在荷兰紧急治疗期间应用于急性护理团队之间安全数据共享的用例时对原型的改进。
方法：我们对医疗专业人员进行了14次半结构化访谈，在急性护理中扮演4个重要角色：紧急呼叫中心，救护车服务,急诊医院,和全科医生诊所。我们使用深度访谈来捕捉他们对应用程序的设计和功能及其在模拟急性护理事件中的使用的看法。我们使用访谈笔录的主题分析。招募参与者，直到收集的数据达到主题饱和。
结果：参与者的看法和反馈被呈现为从访谈中确定的5个主题：当前的挑战（主题1），共享EMR数据的质量(主题2)，EMR数据的完整性和可审计性(主题3)，应用程序的实用性和功能（主题4），以及对技术的信任和接受(主题5)。结果加强了急性中风护理期间患者数据共享的当前挑战。此外，从用户的角度来看，我们表达了在真实场景中采用高级安全云加密平台在医疗保健急性卒中护理应用中的国际编排解决方案所面临的挑战，并提供了改进建议技术可接受性的建议。
结论：这项研究认可了一个系统，该系统可以有效地支持急性护理专业人员之间的数据共享，但不影响患者的安全和隐私.这项探索性研究确定了未来接受和采用拟议系统的几个重大障碍和改进机会。此外，研究结果强调，所需的数字转换应考虑集成已经存在的系统，而不是要求迁移到新的集中式系统。
目的：我们开发了一个基于云的安全EMR应用程序原型。该应用程序探讨了基于eHealth云的框架提供的安全功能，该框架由高级安全云加密平台为医疗保健Horizon2020中的国际编排解决方案创建。这项研究旨在收集印象，挑战,以及在荷兰紧急治疗期间应用于急性护理团队之间安全数据共享的用例时对原型的改进。
方法：我们对医疗专业人员进行了14次半结构化访谈，在急性护理中扮演4个重要角色：紧急呼叫中心，救护车服务,急诊医院,和全科医生诊所。我们使用深度访谈来捕捉他们对应用程序的设计和功能及其在模拟急性护理事件中的使用的看法。我们使用访谈笔录的主题分析。招募参与者，直到收集的数据达到主题饱和。
结果：参与者的看法和反馈被呈现为从访谈中确定的5个主题：当前的挑战（主题1），共享EMR数据的质量(主题2)，EMR数据的完整性和可审计性(主题3)，应用程序的实用性和功能（主题4），以及对技术的信任和接受(主题5)。结果加强了急性中风护理期间患者数据共享的当前挑战。此外，从用户的角度来看，我们表达了在真实场景中采用高级安全云加密平台在医疗保健急性卒中护理应用中的国际编排解决方案所面临的挑战，并提供了改进建议技术可接受性的建议。
结论：这项研究认可了一个系统，该系统可以有效地支持急性护理专业人员之间的数据共享，但不影响患者的安全和隐私.这项探索性研究确定了未来接受和采用拟议系统的几个重大障碍和改进机会。此外，研究结果强调，所需的数字转换应考虑集成已经存在的系统，而不是要求迁移到新的集中式系统。
